Systemic treatment of allergies

Allergic rhinokonjunctivitis or asthma bronchiale and urticaria with or without angioedema are the most prevalent allergic diseases in childhood. Symptomatic relief can be achieved with antihistamines, corticosteroids and partially with the anti-immunoglobulin E (IgE) antibody omalizumab. Bradykinin-dependent angioedema, especially in childhood as the primary manifestation of hereditary angioedema (HAE), has to be ruled out as a differential diagnosis of histamine-induced angioedema. For HAE different therapy options in acute attacks and long-term prophylaxis are available. Timely initiation of specific immunotherapy for IgE-mediated allergy to aeroallergens, sublingually or subcutaneously (SCIT) applied, should be considered. Insect venom allergy can be treated with SCIT. Diagnosis of eosinophilic esophagitis is often delayed. Bolus events may be indicative of the disease. Elimination diets, proton pump inhibitors, topical corticosteroids and dupilumab may be used.